Targeted Dosing as a Precision Health Approach to Pharmacotherapy in Children with Inflammatory Bowel Disease

Wren, Anava A.; Park, K T

doi:10.1001/amajethics.2018.841

Cited by 4 publications

(2 citation statements)

References 28 publications

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“…The reviews have shown a consistent cost benefit with a reactive TDM strategy vs. empiric escalation ( 31 ) and drug durability benefit with the proactive strategy ( 32 , 33 ). This assumes greater importance in pediatrics as IBD specialists try to factor in insurance coverage and payor–payee concerns into pharmacotherapeutic decision-making ( 34 ).…”

Section: Methodsmentioning

confidence: 99%

Advances in Therapeutic Drug Monitoring in Biologic Therapies for Pediatric Inflammatory Bowel Disease

Kapoor

Crowley

2021

Front. Pediatr.

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In the current era of treat-to-target strategies, therapeutic drug monitoring (TDM) has emerged as a potential tool in optimizing the efficacy of biologics for children diagnosed with inflammatory bowel disease (IBD). The incorporation of TDM into treatment algorithms, however, has proven to be complex. “Proactive” TDM is emerging as a therapeutic strategy due to a recently published pediatric RCT showing a clear benefit of “proactive” TDM in anti-TNF therapy. However, target therapeutic values for different biologics for different disease states [ulcerative colitis (UC) vs. Crohn's disease (CD)] and different periods of disease activity (induction vs. remission) require further definition. This is especially true in pediatrics where the therapeutic armamentarium is limited, and fixed weight-based dosing may predispose to increased clearance leading to decreased drug exposure and subsequent loss of response (pharmacokinetic and/or immunogenic). Model-based dosing for biologics offers an exciting insight into dose individualization thereby minimizing the chances of losing response. Similarly, point-of-care testing promises real-time assessment of drug levels and individualized decision-making. In the current clinical realm, TDM is being used to prolong drug durability and efficacy and prevent loss of response. Ongoing innovations may transform it into a personalized tool to achieve optimal therapeutic endpoints.

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Section: Methodsmentioning

confidence: 99%

Advances in Therapeutic Drug Monitoring in Biologic Therapies for Pediatric Inflammatory Bowel Disease

Kapoor

Crowley

2021

Front. Pediatr.

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“…Pediatric IBD represents a special group of patients, where the limited therapeutic armamentarium and challenges in balancing drug safety and efficiency created a critical need for drug monitoring[ 21 ]. Pro-active TDM showed to increase corticoid-free clinical remission in children with CD treated with Adalimumab (ADL) compared with reactive monitoring (PAILOT study)[ 22 ] and sustained clinical remission in children with CD, ulcerative colitis or IBD-unclassified treated with either IFX or ADL therapy[ 23 ].…”

Section: To the Editormentioning

confidence: 99%

Therapeutic drug monitoring in inflammatory bowel disease: At the right time in the right place

Truta¹

2022

WJG

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Therapeutic drug monitoring (TDM) was one of most sought-after objective tools to determine therapeutic efficiency of different biologics and its role in the management of patients with inflammatory bowel disease (IBD) was regarded with great anticipation. But implementation of the TDM in clinical practice was challenged by several factors including uncertainty of the optimal cut-off values, assay variable sensitivity in detecting drug levels and antibodies and, most importantly, individual pharmacokinetics. While reactive TDM was embraced in clinical practice as a useful tool in assessing lack of response to therapy, the utility of proactive TDM in managing IBD therapy is still challenged by the lack of consistency between evidence. Described here, there are four groups of IBD patients for whom proactive TDM has the potential to greatly impact their therapeutic outcomes: Patients with perianal Crohn’s disease, patients with severe ulcerative colitis, pregnant women with IBD and children. As the future of IBD management moves towards personalizing treatment, TDM will be an important decision node in a machine learning based algorithm predicting the best strategy to maximize treatment results while minimizing the loss of response to therapy.

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Ethical considerations in precision medicine

Parker

2024

The New Era of Precision Medicine

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Targeted Dosing as a Precision Health Approach to Pharmacotherapy in Children with Inflammatory Bowel Disease

Cited by 4 publications

References 28 publications

Advances in Therapeutic Drug Monitoring in Biologic Therapies for Pediatric Inflammatory Bowel Disease

Advances in Therapeutic Drug Monitoring in Biologic Therapies for Pediatric Inflammatory Bowel Disease

Therapeutic drug monitoring in inflammatory bowel disease: At the right time in the right place

Ethical considerations in precision medicine

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